(Last) (First) (Middle)
Street City State Zip
W Box Hall & Room Number
Signature_________________________________ Date______________________
|
|
|
|
|
|
|
|
|
|
|
|
|
| 2004 Rush Registration Form | ||||||||||||
| Please return this completed form with 8 pictures and a $30 registration fee by September 3rd.. Any applications received after this deadline will have a $35 registration fee. Please mail to Interclub, 1100 College Street, W-1624, Columbus, MS 39701 or drop it off by the Office of Student Life in upstairs Hogarth. If you are writing a check, make it payable to Interclub. If necessary, please continue any information onto an attached sheet. | ||||||||||||
| Full Name ___________________________________________________________ (Last) (First) (Middle) |
||||||||||||
| Preferred Name _____________________ Date of Birth______________________ | ||||||||||||
| Home Address_________________________________________________________ Street City State Zip |
||||||||||||
| Phone_______________________ Social Security Number_____________________ | ||||||||||||
| Email _______________________ Anticipated Major__________________________ | ||||||||||||
| MUW Address_________________________________________________________ W Box Hall & Room Number |
||||||||||||
| College Classification ___Freshman ___Sophomore ___Junior ___Senior | ||||||||||||
| High School Attended___________________________________________________ | ||||||||||||
| High School GPA_______________ ACT/SAT______________________ | ||||||||||||
| College Attended____________________________ College GPA____________ | ||||||||||||
| Tshirt Size ___Small ___Medium ___Large ___X Large ___XX Large | ||||||||||||
| If anyone in your family has been in a Social Club, list the name, relationship to you & club. | ||||||||||||
| Clubs, Organizations, & Offices Held: | ||||||||||||
| Scholastic & Other Honors: | ||||||||||||
| Special Talents: | ||||||||||||
| I confirm that the above information is true and correct, and I give my permission for the release of personal and academic information, which may be required by MUW Interclub Council. Signature_________________________________ Date______________________ |
||||||||||||